| NPI | 1972058964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 109492) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32227) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2024-02-15 |